Are adverse outcome rates higher in multiple sclerosis patients after total hip arthroplasty?

AimsThis study compared multiple sclerosis (MS) patients who underwent primary total hip arthroplasty (THA) with a matched cohort. Specifically, we evaluated: 1) implant survivorship; 2) functional outcomes (modified Harris Hip Scores (mHHS), Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR), and modified Multiple Sclerosis Impact Scale (mMSIS) scores (with the MS cohort also evaluated based on the disease phenotype)); 3) physical therapy duration and return to function; 4) radiographic outcomes; and 5) complications.Patients and MethodsWe reviewed our institution’s database to identify MS patients who underwent THA between January 2008 and June 2016. A total of 34 MS patients (41 hips) were matched in a 1:2 ratio to a cohort of THA patients who did not have MS, based on age, body mass index (BMI), and Charlson/Deyo score. Patient records were reviewed for complications, and their functional outcomes and radiographs were reviewed at their most recent follow-up.ResultsCompared with the matched cohort, MS patients had lower all-cause implant survivorship at eight years (91.5% (95% confidence interval (CI) 82.7 to 100) vs 98.7% (95% CI 96.2 to 100)) (p = 0.033), lower mHHS scores (66 vs 80, p < 0.001), and HOOS JR scores (79 vs 88, p = 0.009). Multiple sclerosis patients also required more physiotherapy (five weeks vs three weeks, p = 0.002) and took longer to return to baseline (seven weeks vs five weeks, p = 0.010) than the matched cohort. Furthermore, MS patients had more complications than the non-MS patients (six vs zero, p < 0.001). The worse outcomes of the MS group can potentially be explained by predisposition of these patients to mechanical complications and progression of their disease during the period of this study, as demonstrated by worsening of the mMSIS scores (2.9 vs 3.4; p = 0.008).ConclusionMS patients had lower implant survivorship, lower functional outcome scores, and increased complication rates; in addition, MS patients took longer to return to their baseline functional level after THA. Cite this article: Bone Joint J 2018;100-B:875–81.

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Clinical, Functional and Radiographic Outcomes of Primary Total Hip Arthroplasty between Direct Anterior Approach and Posterior Approach: a Systematic Review and Meta-analysis

10.21203/rs.2.21945/v1 ◽

2020 ◽

Author(s):

Linbo Peng ◽

Yi Zeng ◽

Yuangang Wu ◽

Junfeng Zeng ◽

Yuan Liu ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Functional Outcomes ◽

Meta Analysis ◽

Direct Anterior Approach ◽

Total Hip ◽

Randomized Controlled ◽

Radiographic Outcomes ◽

Significant Difference ◽

Primary Total Hip Arthroplasty

Abstract Background: The purpose of this systematic review and meta-analysis was to compare the clinical, functional and radiographic outcomes of primary total hip arthroplasty between the direct anterior approach and posterior approach. Methods: We searched the PubMed, EMBASE databases and Cochrane library from the inception dates to November 1, 2019. And we also searched for the meta-analysis which was published in the past for randomized controlled trials. Results: A total of 7 randomized controlled trials with 600 participants fulfilled the inclusion criteria. Among these, 301 and 299 patients were in the DAA and PA groups, respectively. DAA was associated with a longer surgery time by a mean of 13.74 min (95% CI 6.88 to 20.61, p < 0.0001, I2=93%). Postoperative early functional outcomes were significantly better in the DAA group than PA group such as Visual Analogue Scale (VAS) postoperative 1 day (MD=-0.65, 95% CI -0.91 to -0.38,p < 0.00001, I2=0%), VAS score postoperative 2 days (MD=-0.67, 95% CI -1.34 to -0.01, p =0.05,I2=88%) and Harris Hip Score (HHS) postoperative 6 weeks(MD=6.05, 95% CI 1.14 to 10.95, p =0.02, I2=52%).There was no significant difference between the DAA and PA groups at length of incision, length of stay(LOS), blood loss, transfusion rates or complication rates. We found no significant difference between the two groups about late functional outcomes such as VAS score postoperative 12 months or HHS scores postoperative 3, 6, 12 months. A significant difference in Radiographic outcomes can not be detected too. Conclusions: DAA needs longer surgery time than PA in primary total hip arthroplasty. The DAA offers better early functional recovery than PA. There is no significant difference between the two groups in terms of other clinical, complication, late functional and radiographic outcomes. The evidence about the superiority of DAA is insufficient, which needs more research.

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The effect of time to surgery on outcomes and complication rates following total hip arthroplasty for fractured neck of femur

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0032 ◽

2019 ◽

Vol 101 (5) ◽

pp. 342-345

Author(s):

J Craik ◽

R Geleit ◽

J Hiddema ◽

E Bray ◽

R Hampton ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Length Of Stay ◽

Hip Arthroplasty ◽

Functional Outcomes ◽

Best Practice ◽

Complication Rates ◽

Delayed Presentation ◽

Fractured Neck Of Femur ◽

Neck Of Femur ◽

Total Hip

Introduction Total hip arthroplasty is recommended for elderly patients with fractured neck of femur who are independently mobile, have few co-morbidities and are not cognitively impaired. Providing a daily total hip arthroplasty service is challenging for some units in the UK and considering that these patients may be physiologically distinct from the average hip fracture patient, loss of the best practice tariff as a result of surgical delay may be unjustified. The aim of this study was to determine whether time to surgical intervention for patients eligible for total hip arthroplasty had a negative impact on patient complications, length of stay and functional outcomes. Methods All patients undergoing total hip arthroplasty for fractured neck of femur at our institution over a ten-year period were identified. Complications and functional outcomes were compared between patients receiving total hip arthroplasty before and after 36 hours. Results Of 112 consecutive patients undergoing total hip arthroplasty, 70 responded to a questionnaire or telephone consultation. Four patients were excluded owing to delayed presentation, the presence of advanced rheumatoid arthritis or a pathological fracture. Two-thirds (64%) of the remaining 66 patients underwent surgery within 36 hours of presentation. There were no significant differences between the groups of patients receiving surgery before or after 36 hours with regard to postoperative length of stay, complications, Oxford hip scores or visual analogue scale scores for state of health. Conclusions Delaying surgery for patients eligible for total hip arthroplasty as per the National Institute for Health and Care Excellence guidelines is justified and should not incur loss of the best practice tariff.

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Total hip arthroplasty in patients affected by poliomyelitis

The Bone & Joint Journal ◽

10.1302/0301-620x.100b6.bjj-2018-0127.r1 ◽

2018 ◽

Vol 100-B (6) ◽

pp. 733-739 ◽

Cited By ~ 2

Author(s):

C. M. DeDeugd ◽

K. I. Perry ◽

W. H. Trousdale ◽

M. J. Taunton ◽

D. G. Lewallen ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Joint Infection ◽

Complication Rates ◽

Total Hip ◽

Radiographic Outcomes ◽

Prosthetic Joint ◽

Unaffected Control ◽

Long Term Follow Up ◽

History Of

Aims The aims of this study were to determine the clinical and radiographic outcomes, implant survivorship, and complications of patients with a history of poliomyelitis undergoing total hip arthroplasty (THA) in affected limbs and unaffected limbs of this same population. Patients and Methods A retrospective review identified 51 patients (27 male and 24 female, 59 hips) with a mean age of 66 years (38 to 88) and with the history of poliomyelitis who underwent THA for degenerative arthritis between 1970 and 2012. Immigrant status, clinical outcomes, radiographic results, implant survival, and complications were recorded. Results In all, 32 THAs (63%) were performed on an affected limb, while 27 (37%) were performed on an unaffected limb. The overall ten-year survivorship free from aseptic loosening, any revision, or any reoperation were 91% (95% CI 0.76 to 0.99), 91% (95% CI 0.64 to 0.97) and 87% (95% CI 0.61 to 0.95), respectively. There were no revisions for prosthetic joint infection. There were no significant differences in any of the above parameters if THA was on the affected or unaffected control limbs. Conclusion Patients with a history of poliomyelitis who undergo THA on the affected or unaffected limbs have similar results with overall survivorship and complication rates to those reported results in patients undergoing THA for osteoarthritis. At long-term follow-up, previous clinical concerns about increased hip instability due to post-polio abductor weakness were not observed. Cite this article: Bone Joint J 2018;100-B:733–9.

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Minimizing complications in bikini incision direct anterior approach total hip arthroplasty: A single surgeon series of 865 cases

Journal of Experimental Orthopaedics ◽

10.1186/s40634-020-00318-7 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Avinash Alva ◽

Ikram Nizam ◽

Sophia Gogos

Keyword(s):

Total Hip Arthroplasty ◽

Clinical Outcomes ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Direct Anterior Approach ◽

Womac Score ◽

Complication Rates ◽

Term Survival ◽

Total Hip ◽

Implant Survivorship

Abstract Purpose The purpose of this study was to report all complications during the first consecutive 865 cases of bikini incision direct anterior approach (DAA) total hip arthroplasty (THA) performed by a single surgeon. The secondary aims of the study are to report our clinical outcomes and implant survivorship. We discuss our surgical technique to minimize complication rates during the procedure. Methods We undertook a retrospective analysis of our complications, clinical outcomes and implant survivorship of 865 DAA THA’s over a period of 6 years (mean = 3.9yrs from 0.9 to 6.8 years). Results The complication rates identified in this study were low. Medium term survival at minimum 2-year survival and revision as the end point, was 99.53% and 99.84% for the stem and acetabular components respectively. Womac score improved from 49 (range 40–58) preoperatively to 3.5(range 0–8.8) and similarly, HHS scores improved from 53(range 40–56) to 92.5(range 63–100) at final follow-up (mean = 3.9 yrs) when compared to preoperative scores. Conclusions These results suggest that bikini incision DAA technique can be safely utilised to perform THA.

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Robotic arm-assisted versus manual total hip arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.103b6.bjj-2020-1856.r1 ◽

2021 ◽

Vol 103-B (6) ◽

pp. 1009-1020 ◽

Cited By ~ 1

Author(s):

Nathan Ng ◽

Paul Gaston ◽

Philip M. Simpson ◽

Gavin J. Macpherson ◽

James T. Patton ◽

...

Keyword(s):

Systematic Review ◽

Total Hip Arthroplasty ◽

Learning Curve ◽

Hip Arthroplasty ◽

Functional Outcomes ◽

Meta Analysis ◽

Robotic Arm ◽

Complication Rates ◽

Total Hip

Aims The aims of this systematic review were to assess the learning curve of semi-active robotic arm-assisted total hip arthroplasty (rTHA), and to compare the accuracy, patient-reported functional outcomes, complications, and survivorship between rTHA and manual total hip arthroplasty (mTHA). Methods Searches of PubMed, Medline, and Google Scholar were performed in April 2020 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Search terms included “robotic”, “hip”, and “arthroplasty”. The criteria for inclusion were published clinical research articles reporting the learning curve for rTHA (robotic arm-assisted only) and those comparing the implantation accuracy, functional outcomes, survivorship, or complications with mTHA. Results There were 501 articles initially identified from databases and references. Following full text screening, 17 articles that satisfied the inclusion criteria were included. Four studies reported the learning curve of rTHA, 13 studies reported on implant positioning, five on functional outcomes, ten on complications, and four on survivorship. The meta-analysis showed a significantly greater number of cases of acetabular component placement in the safe zone compared with the mTHA group (95% confidence interval (CI) 4.10 to 7.94; p < 0.001) and that rTHA resulted in a significantly better Harris Hip Score compared to mTHA in the short- to mid-term follow-up (95% CI 0.46 to 5.64; p = 0.020). However, there was no difference in infection rates, dislocation rates, overall complication rates, and survival rates at short-term follow-up. Conclusion The learning curve of rTHA was between 12 and 35 cases, which was dependent on the assessment goal, such as operating time, accuracy, and team working. Robotic arm-assisted total hip arthroplasty was associated with improved accuracy of component positioning and functional outcome, however no difference in complication rates or survival were observed at short- to mid-term follow-up. Overall, there remains an absence of high-quality level I evidence and cost analysis comparing rTHA and mTHA. Cite this article: Bone Joint J 2021;103-B(6):1009–1020.

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The current role of robotics in total hip arthroplasty

EFORT Open Reviews ◽

10.1302/2058-5241.4.180088 ◽

2019 ◽

Vol 4 (11) ◽

pp. 618-625 ◽

Cited By ~ 4

Author(s):

Babar Kayani ◽

Sujith Konan ◽

Atif Ayuob ◽

Salamah Ayyad ◽

Fares S. Haddad

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Functional Outcomes ◽

Learning Curves ◽

Leg Length ◽

Acetabular Cup ◽

Total Hip ◽

Implant Survivorship ◽

Improved Accuracy ◽

Cup Positioning

Robotic total hip arthroplasty (THA) improves accuracy in achieving the planned acetabular cup positioning compared to conventional manual THA. Robotic THA improves precision and reduces outliers in restoring the planned centre of hip rotation compared to conventional manual THA. Improved accuracy in restoring hip biomechanics and acetabular cup positioning in robotic THA have not translated to any differences in early functional outcomes, correction of leg-length discrepancy, or postoperative complications compared to conventional manual THA. Limitations of robotic THA include substantive installation costs, additional radiation exposure, steep learning curves for gaining surgical proficiency, and compatibility of the robotic technology with a limited number of implant designs. Further higher quality studies are required to compare differences in conventional versus robotic THA in relation to long-term functional outcomes, implant survivorship, time to revision surgery, and cost-effectiveness. Cite this article: EFORT Open Rev 2019;4:618-625. DOI: 10.1302/2058-5241.4.180088

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Faculty Opinions recommendation of Effects of regional versus general anesthesia on outcomes after total hip arthroplasty: a retrospective propensity-matched cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725338260.793511854 ◽

2015 ◽

Author(s):

Henrik Kehlet

Keyword(s):

Cohort Study ◽

Total Hip Arthroplasty ◽

General Anesthesia ◽

Hip Arthroplasty ◽

Matched Cohort ◽

Total Hip ◽

Matched Cohort Study

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Clinical, functional and radiographic outcomes after revision total hip arthroplasty with tapered fluted modular or non-modular stems: a systematic review

Hip International ◽

10.1177/11207000211004383 ◽

2021 ◽

pp. 112070002110043

Author(s):

Antonios A Koutalos ◽

Sokratis Varitimidis ◽

Konstantinos N Malizos ◽

Theofilos Karachalios

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Revision Rate ◽

Clinical Results ◽

Fracture Rate ◽

Revision Total Hip Arthroplasty ◽

Term Survival ◽

Total Hip ◽

Radiographic Outcomes

Purpose: The aim of the study was to systematically evaluate clinical outcomes of tapered fluted stems, either monoblock or modular, in revision total hip arthroplasty. Methods: PubMed, EMBASE and Web of Science and Cochrane databases were systematically searched by 2 researchers. Clinical studies reporting primarily on survival and re-revision rates, and secondarily on subsidence, dislocation, intraoperative fractures, periprosthetic fractures and infection were included. 2 investigators assessed the quality of the studies. Results: 46 studies were included in this review, reporting on 4601 stem revisions. The pooled re-revision rate was 5.1% and long-term survival ranged from 75% to 98.5%. No differences were observed between monoblock and modular stems regarding re-revision rate, dislocation rate, periprosthetic fracture rate or infection rates. Monoblock stems exhibited more subsidence and modular stems displayed more intraoperative fractures. Conclusions: Satisfactory results can be obtained with the use of tapered fluted end-bearing stems. Monoblock stems offer the same clinical results as modular stems.

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